EPIDIDYMOORCHITIS IN PEDIATRIC PATIENTS: ARE ANTIBIOTICS NECESSARY?

You have accessJournal of UrologyPediatrics: Urinary Tract Infection/Vesicoureteral Reflux1 Apr 2013660 EPIDIDYMOORCHITIS IN PEDIATRIC PATIENTS: ARE ANTIBIOTICS NECESSARY? Evalynn Vasquez, Brendan Frainey, Michaella Prasad, Bruce Lindgren, and Earl Cheng Evalynn VasquezEvalynn Vasquez Chicago, IL More articles by this author , Brendan FraineyBrendan Frainey Chicago, IL More articles by this author , Michaella PrasadMichaella Prasad Chicago, IL More articles by this author , Bruce LindgrenBruce Lindgren Chicago, IL More articles by this author , and Earl ChengEarl Cheng Chicago, IL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.213AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Traditionally, pediatric patients with epididymoorchitis (EO) are treated with antibiotic therapy despite negative results found on urinalysis and urine culture. The purpose of this study is to identify the relationship between urinalysis and urine culture results with treatment of these patients. METHODS A query was performed for males aged 0-12 years who presented to the Emergency Department from 2000-2010 in which an ICD9 code had been entered for EO, scrotal pain, torsion of testis or appendix epididymis/testis, or unspecified disorder of male genitalia in order to capture all patients with a final diagnosis of EO. Patients with hypervascularity of the epididymis/testis demonstrated on a scrotal ultrasound were included. Exclusion criterion was known congenital urologic abnormalities. Through a retrospective chart review, data was collected regarding patient history, physical examination, laboratory and radiology results, treatment, and follow up. Data was analyzed to determine the correlation between presentation, urinalysis/urine culture, and treatment. RESULTS 2412 patients were identified using the described ICD9 code query. 161 patients met inclusion criteria. Median age was 9.1 years (range 0.2-12 years). Urine was collected in 144 patients. 135 (94%) had a negative urinalysis and 9 (6%) had a positive urinalysis. Only 3 patients had both positive urinalysis and urine culture. All 3 patients were 6 months old or less, not circumcised, and had urine specimens obtained by catheterization. The remaining 6 patients with a positive urinalysis had negative urine cultures. A total of 74 (46%) patients were treated with antibiotics. 87 (54%) patients were treated with nonsteroidal anti-inflammatories, acetaminophen, and supportive measures. Urinalysis/culture results did not correlate with antibiotic treatment (p=0.23). Follow up was available on 59 patients. Median follow up was 3 weeks. 39 patients reported resolution of symptoms, 14 reported persistent symptoms, 5 reported worsening symptoms. There was no statistically significant difference between resolution, persistence, or worsening of symptoms and antibiotic treatment (p=0.92). CONCLUSIONS Our study found that sterile urine is exclusively found in boys greater than 1 year of age diagnosed with EO. This suggests, that in this population, EO is noninfectious in nature and implies an inflammatory response from sterile urine (chemical EO) that does not require antibiotic treatment. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e270 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Evalynn Vasquez Chicago, IL More articles by this author Brendan Frainey Chicago, IL More articles by this author Michaella Prasad Chicago, IL More articles by this author Bruce Lindgren Chicago, IL More articles by this author Earl Cheng Chicago, IL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...